|
APPENDIX B
<br />To Service Agreement No. HMR-SA-17-005
<br />with the Kittitas County Sheriffs Office
<br />June 29 & July 6, 2017
<br />CRF HC00213 2-3
<br />Volpentest HAMMER Federal Training Center/Patrol Training Academy
<br />GENERAL RELEASE AND INDEMNIFICATION
<br />U.S. Citizens
<br />I, the undersigned, expressly acknowledge that my participation in the Volpentest HAMMER
<br />Federal Training Center (HAMMER)/Patrol Training Academy (PTA) training activities may expose
<br />me, either directly or indirectly, to certain hazards inherent in the transportation to, viewing of,
<br />and participating in the operation oftraining props and demonstrations. Such hazards may give
<br />rise to personal injury, including death, or property damage or loss.
<br />I have been informed and understand that Mission Support Alliance, LLC (MSA) and the U.S.
<br />Department of Energy (DOE) do not provide accident, health, medical, disability, or other types
<br />of insurance for the protection of those who participate in the HAMMER/PTA training activities.
<br />Furthermore, I understand that it is recommended that I have a medical insurance policy in
<br />effect during my participation.
<br />I certify that if I have any reason (physical, medical or otherwise) which would impact my ability
<br />to participate in this training, I will advise HAMMER/PTA staff of my condition and follow
<br />instructions given me by HAMMER/PTA staff.
<br />In consideration of the priv'ilege of participating in HAMMER/PTA training activities, the
<br />undersigned, for myself, my heirs, administrators, executors, successors, representatives, and
<br />assigns, do hereby knowingly, willingly, and voluntarily assume any and all risks of accident,
<br />personal injury, or property damage to myself and to my property consistent with the State of
<br />Washington Comparative Fault Statute (R.C.W. 4.22). I agree to now and forever release, acquit,
<br />discharge, indemnify, and hold harmless MSA and DOE, their officers, officials, directors,
<br />representatives, agents, employees, and contractors, from and against any and all claims, loss,
<br />causes of action, suits, cost or expense for any and all personal injury, death, or property
<br />damage arising directly or indirectly from my participation in HAMMER/PTA training activities.
<br />Participant's Signature Date
<br />Participant's Name (Print)
<br />Organization, Company, Affiliation (Print)
<br />5/9/17
|